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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
CREDIT/STANDARD DEDUCTION Hcio
Bf State Form 5473 (R5/ 10 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
7r CERTIF196n04 STATEMENT'-
I (We) cl
I F0jn csir
IL Ey
a, 't 1 0—
I (We) ied as �`prhnciipal place of residence the foffowing described real property for which a Homes Is hDacrned
��z 7s
,2001 (We) owned ❑ Are buying under contract
•Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propSERr ijb&rZWer a contract.
CONTRACT' RECORDED
ro-
If buying on contract, Fee Simple owner's name GIBSON COUNTY AUDITOR I
Recorders office where contract is recorded Record number I Page
'-"-'zOkOOEkTY OWNED BY CLAIMANT INOTHER-COUNTIES�-"�--."':"--"-�tt!e,-'-�,---
-PROPE RTYIDE
CRIP ON'r,.
County Tovn hip
I hereby certify the above statements are true, correct and complete.
T n di ct wn, towns��..
VALUE,
01 Tb�r e on
_00q34_ %,Sgald
1.hbVerT tree city, stale, ZT&kV_,,
Is the properly in q s . n:
eat property ❑ Mobile Homo (I.C. 6- 1.1 -7)
If any portion of the residenUil-structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property tififted to produce income.
'-"-'zOkOOEkTY OWNED BY CLAIMANT INOTHER-COUNTIES�-"�--."':"--"-�tt!e,-'-�,---
County
Tmnship
County Toomship
I hereby certify the above statements are true, correct and complete.
Sit�ature of cl ima ,,
VALUE,
-AT
1.hbVerT tree city, stale, ZT&kV_,,
VALUE'
�,;,AdSE§S&R
-,jRUE-7A)C-
ASSESSED VALUE
-HOMESTEAD
NOWRESIDENTIAC�'
USE ONLY-%,
VALUE,
-AT
VALUEG:
VALUE'
Land not exceeding I (one) acre immediately
surrounding residential improvements.
2T
Otherland
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
;_L; %
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuaticip or $6.000
HALE FORM!!!fn1R:/NMI WRFAVILER PORN 75-1A
ANTI/CEO BY ft OE BOAROO.ArmiraS,IOU P6YRIBFD BY rut DEPARTR`IT OF LOCAL GOVEILNWNT FINANCE ea-,.1.22-1.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• PRINCETON IN 47670 Individuals and married couple are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive tan e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the hornestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filimm.This information will be kept confidential and can only be accessed by authorized county officials.The Ikpannent of
Local Gmcrunent Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Pinkston, April S •
'f�` PoBox2lg 1 1St*DAY
_ 4 v �� Patoka IN-17656
93 �} Co vf4C}r
ofj flywo
April S Pinkston
P O Box 333 State Parcel Number Legal Description
PATO/CA IN 47666-0333
IPIrtllrtrlPllttrllttnllttll IIttPIlttPlltttlltttllttllrtl 26-04-24-302-000.436-020 016.00436-00 COL DIV 7
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
• Pr A\ ShGnno r\ ‘t1V-S A
mg Address(nu tad street,city,state,and ZIP code) Same as property oddness
\ oC a?\°kr /P o 2,ox%33 S—kli . - - N\ y.-7 la t? Co
.'use First Middle Last
Mailing Address(Number and street,city.state,an, -• ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(pleases• ••, • : 4 below)
sew
— PART 3:CERTIFICATION 1'- -_ --
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
—
am I Signature c";XJ n j Date
S - ignamre Date Telephone
( )
•' .\ PART 4:ADDITIONAL INFORMATION